How to make everyone benefit from eHealth applications

Article posted on: 14 July 2016

Blog post written based on the eHealth Week 2016 session “eHealth Equity: how to meet the needs of people with poor health literacy”, Friday, June 10

Knowledge inequity

Much has been said about the promising effects of eHealth such as fast knowledge dissemination and thus reduced “knowledge inequity”. In other words, anyone can find anything online or with apps, and patients and healthcare professionals can use the same information, which contributes to better collaboration and thus leads to the “patients as partners” concept. Although many people have become Internet and smartphone savvies, this does not imply that health apps work for everyone. Pharos, the Dutch Centre of Expertise on Health Disparities, organised an interactive workshop on this topic during eHealth Week 2016 in Amsterdam.


Lessons learned

The session consisted of keynote lectures followed by an eHealth developing contest for teams. First, Chandra Verstappen confronted the audience with some facts. She stated that there is a large group (up to 25% of the Dutch population) of people with limited health literacy, and that many apps and health related websites are not suitable for them. Subsequently, Vanessa Mason shared tips and tricks for developing eHealth interventions for patients with a low socio-economic status. Then, Dr. Olivier Blanson Henkemans, Researcher at TNO, presented how they took into account all end-users’ needs from the beginning during the development of the “Starting Together App”, a tailor-made children’s upbringing approach for low-income groups. He said: “It is all about the end user. He or she should really have the feeling that the app is there for him/her and that it fits to their needs. If that’s not the case an app or intervention will never be successful”. He also described that the user should be in control at all times: “The app shall make data sharing transparent to the user and enable them to select what data they would like to share and with whom (and its implications)”. The next speaker, Robert Boersma, Director of Zorgbelang Zuid-Holland agreed, and added to the discussion by pointing out that developing a good app is just the beginning. He stated: “And even  if you have built a great app, the challenge is to reach people, especially some groups such as lower educated people”. This is what he sees at Zorgbelang Zuid-Holland on a daily basis.

Making apps work by personalisation

After a short discussion with the audience, everyone agreed that eHealth should be “as personalised as possible”, and that one single app will never be the solution for all users: you need different interventions for people with different preferences. Therefore, the participants were divided into teams and were given an assignment: o discuss unique specifications that matter. This was done according to a framework developed by Pharos, with relevant topics regarding text (e.g. are users involved in the story), image (e.g. minimal use of graphs, tables and diagrams) and user-friendliness (e.g. simplicity and instructions).

Where are the end-users?

Overall, it was a valuable session with a good balance of experts from the field and researchers. However, I kept asking myself several times: “If the end-users are so important, where are they during this session?”. Although the eHealth Week was officially “Patients included”, my recommendation is make sure that we invite patients to every session, so we can discuss with patients instead of “about” patients. This will contribute to developing more effective apps.

Dr. Tom H van de Belt
Dr. Tom H van de Belt. Assistant professor REshape Innovation Center, The Netherlands